Predictors for adverse outcomes and recurrence of pyometra: a 10-year retrospective study
Keywords:
Bacteria, Pyometra, RecurrenceAbstract
Objective: To identify predictors for adverse outcomes and recurrence in patients with pyometra.
Methods: Medical records of patients with a diagnosis of pyometra admitted to Tuen Mun Hospital between 1 January 2014 and 31 December 2023 were retrospectively reviewed. Patients’ clinical characteristics, laboratory findings, management options, and clinical outcomes (including treatment- and disease-related complications and recurrence) were collected. Patients with or without composite adverse outcomes were compared, as were patients with or without recurrence. Multivariate logistic regression was used to determine independent predictors for composite adverse outcomes and recurrence.
Results: In total, 152 patients (median age, 79 years) were included in the analysis; the incidence of pyometra was 0.003%. Composite adverse outcome was more likely to occur in those with diabetes mellitus (adjusted odds ratio [aOR]=6.76, p=0.001) or congestive heart failure or a history of acute myocardial infarction (aOR=4.40, p=0.028), those with the longest diameter of the intrauterine pus collection (aOR=1.26, p=0.009), and those with extended-spectrum b-lactamase–positive bacteria (aOR=6.07, p=0.013), whereas composite adverse outcome was less likely to occur in those with vaginal bleeding (aOR=0.14, p=0.002). Of the patients, 24.0% had recurrence. The risk of recurrence increased with the presence of enterococci (aOR=3.31, p=0.022) and those with the longest diameter of the intrauterine pus collection (aOR=1.16, p=0.033).
Conclusion: Pyometra is rare and often associated with malignancy and severe complications. Patients at risk of developing adverse outcomes include those with diabetes mellitus, congestive heart failure or a history of acute myocardial infarction, large pus collection, and infection with extended-spectrum b-lactamase–producing organisms. Patients at risk of recurrence include those with a large pus collection or the presence of enterococci. At-risk patients should be monitored vigilantly. Early diagnosis and intervention are crucial to improving clinical outcomes.
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